{"id":245,"date":"2011-03-25T12:57:07","date_gmt":"2011-03-25T16:57:07","guid":{"rendered":"http:\/\/blogstemp3.wpengine.com\/?p=245"},"modified":"2011-03-25T12:57:07","modified_gmt":"2011-03-25T16:57:07","slug":"h-pylori-is-it-time-to-change-our-first-line-treatment","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/gastroenterology\/index.php\/h-pylori-is-it-time-to-change-our-first-line-treatment\/2011\/03\/25\/","title":{"rendered":"H. pylori: Is it time to change our first-line treatment?"},"content":{"rendered":"<p><em>H. pylor<\/em>i dominated the GI news in the 1990s, and despite it disappearing from the front pages, it remains a common and important clinical problem. The dominant recommended initial treatment strategy has been a clarithromycin-based PPI triple therapy, with either amoxicillin or metronidazole as the third drug. This approach was based on clinical studies, ease of use, and tolerability factors. Bismuth-based quadruple therapy (a bismuth agent, metronidazole, tetracycline, and a PPI), despite demonstrating excellent activity, was usually relegated to second-line therapy because of the complexity of the dosing as well as compliance and tolerability issues.<\/p>\n<p>However, duringthe last decade, the widespread use of macrolides in the general population has led to rising resistance to clarithromycin (by 30% or more of <em>H. pylori<\/em> strains in some areas), and when clarithromycin resistance is present, the efficacy of clarithromycin-containing triple therapy falls from about 80% to 50% or even lower. However, clarithromycin resistance does not affect the efficacy of bismuth-based quadruple therapy, and that efficacy of those regimens remains at about 90% when patients are compliant with the treatment.<\/p>\n<p>So the questions for you to consider are:<br \/>\n1) Do you know what the clarithromycin resistance rate in <em>H. pylori<\/em> is in your community?<br \/>\n2) What first-line\u00a0<em>H. pylori<\/em> treatment regimen do you use?<br \/>\n3) Are you planning to change your <em>H. pylori<\/em> treatment strategy now that clarithromycin resistance rates are rising?<\/p>\n<p>Let us know what you think.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>H. pylori dominated the GI news in the 1990s, and despite it disappearing from the front pages, it remains a common and important clinical problem. The dominant recommended initial treatment strategy has been a clarithromycin-based PPI triple therapy, with either amoxicillin or metronidazole as the third drug. This approach was based on clinical studies, ease [&hellip;]<\/p>\n","protected":false},"author":28,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[13],"tags":[],"class_list":["post-245","post","type-post","status-publish","format-standard","hentry","category-patient-care"],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/gastroenterology\/index.php\/wp-json\/wp\/v2\/posts\/245","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/gastroenterology\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/gastroenterology\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/gastroenterology\/index.php\/wp-json\/wp\/v2\/users\/28"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/gastroenterology\/index.php\/wp-json\/wp\/v2\/comments?post=245"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/gastroenterology\/index.php\/wp-json\/wp\/v2\/posts\/245\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/gastroenterology\/index.php\/wp-json\/wp\/v2\/media?parent=245"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/gastroenterology\/index.php\/wp-json\/wp\/v2\/categories?post=245"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/gastroenterology\/index.php\/wp-json\/wp\/v2\/tags?post=245"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}